The Scheie Eye Institute of the University of Pennsylvania (UP)implemented a community outreach program, 4Sight, to increase rates of annual ophthalmic visits among diabetics in neighboring West Philadelphia. This community is largely African-American, providing a target population at increased risk for blindness due to diabetic retinopathy. It was assumed that the majority of costs to operate the program were not being recuperated through the clinical revenues generated, and for this reason grant funds would be needed to support 4Sight. A cost analysis was conducted to test this hypothesis, and to determine the operating and clinical costs and revenue of the program. A one year time period was selected for the analysis. The payer mix was found to be: 12% uninsured, 17% Medicaid and 71% HMO and commercial payers. Revenue data was obtained from a database maintained by the UP and reflects actual payments recovered. The analysis found average revenues of $153.39 per patient Preliminary estimates based on this information showed the program needed to enroll a total of 717 patients for program operating costs and revenues to break-even. Data from the cost analysis enables program staff to plan and monitor changes to the program size, payer mix and other factors that will affect costs and revenues. Specifically 4Sight plans to increase the number of uninsured, by maintaining a high insured-patient volume and by targeting grant applications to subsidize only uninsured patient care.
Learning Objectives: Participants will a)be able to collect and analyze cost data of an eye care outreach program to quantify and/or increase clinical revenues, and b) understand how to develop eye care outreach that utilizes insured patients to subsidize uninsured patient care.
Keywords: Vision Care, Cost Issues
Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: None
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.